Retention rates of different Janus kinase inhibitors in rheumatoid arthritis: experience from a large monocentric cohort.

OBJECTIVE: The efficacy of Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA) has been clearly shown. However, information on comparative drug retention rates (DRRs) of different JAKi is heterogeneous. The aim of this study was to compute and compare DRRs of different JAKi in a large cohort of RA patients. METHOD: Patients with RA treated with at least one JAKi and followed up at our centre were retrospectively identified. DRRs of each JAKi were computed at 24 months. The association of baseline features with drug persistence was tested. Variations in 28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) and Clinical Disease Activity Index (CDAI) scores between baseline and 12 months were analysed. RESULTS: The study included 365 patients, with a total of 463 therapy courses. Tofacitinib was the most prescribed JAKi (33%), followed by baricitinib (25%), upadacitinib (24%), and filgotinib (21%). The mean treatment duration was 24 ± 17 months, with a maximum of 70 months. At 24 months, the overall DRR was 86%. DRRs were not significantly different across different JAKi. The only baseline predictor of treatment discontinuation was previous treatment with a biological disease-modifying anti-rheumatic drug (bDMARD) (hazard ratio 1.65, 95% confidence interval 1.08-2.53; p = 0.021). There were significant reductions in DAS28-CRP and CDAI 1 year after treatment start. CONCLUSIONS: In our large, monocentric cohort, the overall 24 month DRR for JAKi was greater than 80%. No significant differences in retention were found among different JAKi. Persistence was lower in patients who had previously been treated with other bDMARDs.

Drug development and novel therapeutics to ensure a personalized approach in the treatment of systemic sclerosis.

INTRODUCTION: Systemic sclerosis (SSc) is a systemic disease encompassing autoimmunity, vasculopathy, and fibrosis. SSc is still burdened by high mortality and morbidity rates. Recent advances in understanding the pathogenesis of SSc have identified novel potential therapeutic targets. Several clinical trials have been subsequently designed to evaluate the efficacy of a number of new drugs. The aim of this review is to provide clinicians with useful information about these novel molecules. AREA COVERED: In this narrative review, we summarize the available evidence regarding the most promising targeted therapies currently under investigation for the treatment of SSc. These medications include kinase inhibitors, B-cell depleting agents, and interleukin inhibitors. EXPERT OPINION: Over the next five years, several new, targeted drugs will be introduced in clinical practice for the treatment of SSc. Such pharmacological agents will expand the existing pharmacopoeia and enable a more personalized and effective approach to patients with SSc. Thus, it will not only possible to target a specific disease domain, but also different stages of the disease.

Factors associated with dementia attitudes in an adolescent cohort: Structural Equation Modelling.

Objective: Dementia-related stigma is a key barrier to people living well with dementia, leading to social isolation and poor well-being. Adolescents represent an under-researched group that will become future carers and healthcare workers for the estimated 83.2 million people who will be living with dementia by 2030. Understanding the factors involved in dementia attitude formation in adolescents is useful for the development of evidence-based anti-stigma initiatives. This study aims to identify predictors of dementia attitudes in adolescents. Methods: This is a cross-sectional study using secondary data analysis. 470 participants aged 12-15 years old from secondary schools in the Southeast of England, United Kingdom completed validated questionnaires relating to dementia attitudes (KIDS and Brief A-ADS) as well as demographic information. Multiple regressions were employed as well as a path analysis via a structural equation model to test for direct and mediatory effects. Results: Multiple regression models revealed that being female, having higher levels of contact with dementia, and higher levels of empathy are positively associated with dementia attitudes in adolescents (p<0.05). Within the accepted structural equation model, empathy was a key mediator between contact and dementia attitudes. Conclusion: This study highlights the pivotal role that contact with dementia can have in influencing dementia attitudes in adolescents with empathy serving as a mediator between contact and dementia attitudes. Interventions that use contact should consider how to stimulate empathetic responses to ultimately shape dementia attitudes.

Efficacy of Mepliex® Ag Versus Xeroform® As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard.

Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.

La greffes de peau mince (GPM) demeure une procédure essentielle dans la chirurgie de brûlure et de reconstruction. La zone donneuse de greffe (ZDG) représente une perte de substance cutanée superficielle, cicatrisant spontanément. Il n'y a pas de consensus concernant la prise en charge optimale de la ZDG. Le pansement idéal de la ZDG doit promouvoir la cicatrisation et réduire la douleur ainsi que le risque infectieux. Malgré les nombreuses publications montrant l'intérêt d'un environnement humide pour la cicatrisation, de nombreux chirurgiens réalisent des pansements secs vaselinés. Cette étude rétrospective effectuée dans 2 CTB compare les pansements de ZDG réalisés au Xéroform® ou au Mepilex Ag®. Les infections ont été documentées et, dans un sous-groupe, les scores de douleur et la consommation d'opiacés au long de l'hospitalisation ont été notés. Les taux d'infection sont de 1,2% dans le groupe Mepilex Ag® et 11,4% avec Xéroform® (p<0,0001). Le risque d'infection de la ZDG est augmenté (OR 10,8 ; p = 0,002) en cas d'utilisation de Xéroform®. Il n'y avait pas de différence de douleur et de consommation d'opiacés entre les 2 groupes. Les ZDG recouvertes d'un pansement hydrocellulaire imprégné d'argent s'infectent moins que celles traitées avec une gaze imprégnée de vaseline. L'utilisation sur les ZDG d'un pansement humide comme une mousse hydrocellulaire (par exemple Mepilex Ag®) devrait devenir la norme.

Presenting features and outcomes of cranial-limited and large-vessel giant cell arteritis: a retrospective cohort study.

Objectives: To compare the presenting features and outcomes of patients with cranial-limited (C-) and large-vessel (LV-) giant cell arteritis (GCA).Methods: Data from our GCA cohort were collected retrospectively. Patients who underwent total-body large-vessel imaging within 10 days after commencing steroid therapy were included. Patients with LV involvement were classified as LV-GCA. Presenting features, treatments, and outcomes of LV-GCA and C-GCA patients were compared.Results: 161 patients were included (LV-GCA, n = 100). At baseline, LV-GCA patients were younger than those with C-GCA (73.2 ± 8.9 vs 76 ± 8.8 years, p = 0.018) and had a longer delay to diagnosis (3.5 ± 4.6 vs 2.3 ± 4.9 months, p = 0.001). C-GCA patients had a higher incidence of headache (p = 0.006) and ischaemic optic neuropathy (p < 0.001), whereas LV-GCA patients had more systemic symptoms (fever, p = 0.002; fatigue, p < 0.001; weight loss, p < 0.001; night sweats, p = 0.015) and dry cough (p = 0.031). Corrected cumulative prednisone dose, relapse-free survival, relapse-rate, and incidence of ascending aortic aneurysms were not significantly different between the two subgroups. A steroid-sparing agent was added in 73% of LV- and 55.7% of C-GCA patients (p = 0.027), but was introduced more frequently at baseline in LV-GCA patients (52% vs 23.5%, p = 0.006). LV-GCA patients initially treated with glucocorticoid monotherapy relapsed sooner (relapse-free survival, HR = 0.56, 95% CI 0.41-0.78, p < 0.001) and had a higher relapse rate (relapses per 10 person-years, 6.73 ± 11.50 vs 3.82 ± 10.83, p = 0.011).Conclusion: LV-GCA patients were younger at diagnosis and suffered a longer diagnostic delay. The outcomes of the two subgroups were similar. An earlier introduction of steroid-sparing agents in LV-GCA patients might have played a positive role.

Evaluation of a dementia awareness programme in UK schools: a qualitative study.

OBJECTIVES: 'Dementia Friends' is a programme used to raise awareness of dementia, developed by the Alzheimer's Society, which has been delivered across the UK to diverse populations, including adolescents. However, there is little evidence available with regards to adolescents' perceptions of the programme and its impact. This study aims to explore this in a group of adolescents from the south of England. STUDY DESIGN: Focus group discussions. METHODS: Thirty adolescents aged between 11 and 16 years were recruited from two schools in East Sussex, England. All had participated in a Dementia Friends session in the past month. Focus group discussions were transcribed, coded and themes were created using inductive thematic analysis. RESULTS: Four themes were identified: (1) perceptions and experiences of dementia, (2) outcomes and learning from Dementia Friends session, (3) reactions to the Dementia Friends session and (4) identified future learning needs. CONCLUSIONS: Adolescents had generally positive opinions about Dementia Friends, particularly the interactive nature of the session. Whilst they felt participating in Dementia Friends improved their attitudes and knowledge, they were often left wanting to learn more. Future research needs to empirically evaluate the extent to which Dementia Friends may improve attitudes and knowledge of dementia.

A systematic review and meta-analysis of dementia prevalence in seven developing countries: A STRiDE project.

The STRiDE project sets out to support the development of effective dementia policy in middle-income countries (Brazil, India, Indonesia, Jamaica, Kenya, Mexico, and South Africa). As part of this it will generate new data about the prevalence of dementia for a subset of these countries. This study aims to identify the current estimates of dementia prevalence in these countries and where the gaps lie in the current literature. A systematic review was completed on 30th April 2019 across electronic databases, identifying dementia prevalence literature originating from any of the seven countries. Four hundred and twenty-nine records were identified following de-duplication; 28 studies met the inclusion criteria and were included in the systematic review. Pooled estimates of dementia prevalence ranged from 2% to 9% based on DSM-IV criteria; these figures were generally higher in studies using other diagnostic criteria (e.g. the 10/66 algorithm). Available prevalence data varied between countries. Only Brazil, Mexico and India had data derived from studies judged as having a low risk of bias. Irrespective of country, studies often were not explicit in detailing the representativeness of their sample, or whether there was non-response bias. Further transparent and externally valid dementia prevalence research is needed across the STRiDE countries.

Concentric left ventricular remodelling is associated with subclinical systolic dysfunction in patients with psoriatic arthritis.

Objectives: Subclinical left ventricular (LV) abnormalities have been reported in echocardiographic studies of patients with psoriatic arthritis (PsA). Left ventricular systolic dysfunction (LVSD) often coexists with concentric LV remodelling, an unfavourable prognostic factor that is commonly found in patients at high cardiovascular risk. However, it is unclear whether PsA is associated with concentric LV remodelling. This cross-sectional study assesses the prevalence of and factors associated with concentric LV remodelling in a cohort of patients with PsA, and tests the hypothesis that concentric LV remodelling is a major determinant of LVSD in PsA. Method: We evaluated 101 adults attending an outpatient clinic with PsA diagnosed according to the ClASsification criteria for Psoriatic ARthritis (CASPAR). All patients were free of cardiovascular disease. Patients with PsA were compared with 101 controls matched for age, gender, body mass index, hypertension, and diabetes. Echocardiography was performed: concentric LV remodelling was defined if the relative wall thickness was > 0.43; stress-corrected mid-wall shortening was used as an index of LVSD and considered impaired if < 86.5%. Results: Concentric LV remodelling was found in 58% of patients with PsA and 18% of controls (p < 0.001). LVSD was found in a significantly higher proportion of patients with PsA (56%, p < 0.001) than controls. The presence of PsA yielded a 10-fold higher probability of having LVSD [odds ratio (OR) 9.6, 95% confidence interval (CI) 4.2-21.9, p < 0.0001]. In patients with PsA, concentric LV remodelling increased the risk of LVSD four-fold (OR 3.7, 95% CI 1.3-10.2, p = 0.013). Conclusion: Most asymptomatic patients with PsA have concentric LV remodelling, which is closely associated with subclinical LVSD.

Estudio comparativo de la eficacia de diversas modalidades terapéuticas en pacientes con blefaritis crónica / Comparative study of the efficacy of different treatment options in patients with chronic blepharitis

OBJETIVO: Comparar la eficacia de 3 modalidades de tratamiento en pacientes con blefaritis crónica. METODOLOGÍA: Se realizó un estudio experimental, aleatorizado y controlado en 45 pacientes (sexo femenino: 67%; edad media: 40,5 años) con diagnóstico de blefaritis crónica para comparar la eficacia de 3 modalidades de tratamiento. Grupo 1: higiene palpebral con champú neutro 3 veces/día; grupo 2: higiene palpebral con champú neutro y gel tópico de metronidazol al 0,75% 2 veces/día; grupo 3: higiene palpebral con champú neutro y pomada antibiótica de neomicina al 3,5% y polimixina al 10% con dexametasona al 0,5% 3 veces/día. Los síntomas y signos fueron valorados asignándoles puntuaciones entre 0: sin síntomas ni signos; 1: síntomas o signos leves; 2: síntomas o signos moderados y 3: síntomas o signos severos. RESULTADOS: En los 3 grupos de tratamiento se observó mejora significativa de los signos y síntomas. Mientras que los grupos 1 y 2 presentaron una mayor mejoría en todas las variables estudiadas (p < 0,05), el grupo 3 no presentó mejoría clínica para comezón (p = 0,16), ojo seco (p = 0,29), caída de pestañas (p = 0,16) ni eritema en el borde palpebral (p = 0,29). CONCLUSIÓN: La higiene palpebral con champú neutro y el uso combinado de champú neutro con gel de metronidazol reportaron mejores resultados que la higiene palpebral con champú neutro y pomada antibiótica de neomicina y polimixina con dexametasona

OBJECTIVE: To compare the efficacy of 3 treatment options in patients with chronic blepharitis. METHODOLOGY: An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. RESULTS: A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P < .05), Group 3 showed no clinical improvement for itching (P = .16), dry eye (P = .29), eyelashes falling (P=.16), and erythema at the eyelid margin (P = .29). CONCLUSIONS: Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone

Comparative study of the efficacy of different treatment options in patients with chronic blepharitis.

OBJECTIVE: To compare the efficacy of 3 treatment options in patients with chronic blepharitis. METHODOLOGY: An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. RESULTS: A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). CONCLUSIONS: Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone.

Clinical and epidemiological characteristics of infectious keratitis in Paraguay.

To describe the clinical and epidemiological characteristics of patients with severe infectious keratitis in Asunción, Paraguay between April 2009 and September 2011. All patients with the clinical diagnosis of severe keratitis (ulcer ≥2 mm in size and/or central location) were included. Empiric treatment consisted of topical antibiotics and antimycotics; in cases of advanced keratitis, fortified antibiotics were used. After microbiological analysis, treatment was changed if indicated. In total 48 patients (62.5 % males, 25 % farmers) were included in the analysis. A central ulcer was found in 81.3 % (n = 39). The median delay between onset of symptoms and time of first presentation at our institution was 7 days (range 1-30 days). Fungal keratitis was diagnosed in 64.5 % (n = 31) of patients, of which Fusarium sp. (n = 17) was the most common. Twenty-one patients (43.8 %) reported previous trauma to the eye. The globe could be preserved in all cases. While topical therapy only was sufficient in most patients, a conjunctival flap was necessary in six patients suffering from fungal keratitis. The high rate of fungal keratitis in this series is remarkable, and microbiological analysis provided valuable information for the appropriate treatment. In this setting, one has to be highly suspicious of fungal causes of infectious keratitis.

Frecuencia de colonización por Estreptococo grupo B en embarazadas de 35 a 37 semanas en el Hospital Materno-Infantil San Pablo / Frequency of group B Streptococcus colonization in 35 to 37 weeks pregnant women in the San Pablo Maternal-Child Hospital

La colonización del Estreptococo grupo B en la embarazada está relacionada a patologías perinatales, constituyéndose en una causa muy importante de morbi-mortalidad neonatal. De manera a reducir dicha morbi-mortalidad, el Centro de Control y Prevención de Enfermedades Infecciosas de Estados Unidos desarrolló una estrategia que consiste en realizar el cultivo de muestra tanto vaginal como ano-rectal de todas las mujeres entre 35 y 37 semanas de gestación. El objetivo de este trabajo fue determinar la frecuencia de colonización por Estreptococo β hemolítico grupo B en mujeres gestantes entre las 35-37 semanas de embarazo que concurrieron al Hospital Materno-Infantil San Pablo, Centro de Salud Nº 5, desde abril del 2010 a agosto del 2011. Se realizó un estudio con diseño observacional descriptivo de corte transverso. Las muestras fueron tomadas mediante hisopado de introito vaginal y ano-rectal, colocadas en medio de transporte Stuart y remitidas al Instituto de Investigaciones en Ciencias de la Salud para el cultivo en agar sangre, previo enriquecimiento en caldo Todd Hewitt. La identificación bacteriana se realizó mediante pruebas bioquímicas convencionales y la confirmación mediante aglutinación con látex. La frecuencia de colonización obtenida fue relativamente alta, de 23,6%. Los resultados de este estudio permiten dimensionar la problemática en nuestro país y evidenciar la necesidad de la implementación de un programa a nivel nacional para la detección del Estreptococo grupo B de forma rutinaria en las embarazadas. De esta manera, se podrá disminuir la morbi-mortalidad perinatal y materna con la administración oportuna del tratamiento profiláctico.

Eficacia de la aplicación tópica de 0, 3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas / Efficacy of topical 0.3% ciprofloxacin application in reducing the conjunctival biota of patients undergoing cataract extraction

Objetivo: Determinar la eficacia de la ciprofloxacina tópica al 0,3% en la reducción de la biota conjuntival en pacientes operados de cataratas. Pacientes y métodos: Estudio experimental, prospectivo, aleatorizado, controlado a simple ciego. Cuarenta y seis ojos de 46 pacientes fueron distribuidos al azar en dos grupos: el grupo de estudio (n = 23) recibió ciprofloxacina al 0,3% un día antes de la cirugía a razón de una gota cada 6 h y, luego, en el día de la cirugía, una gota cada 15 min, empezando una hora antes de la cirugía hasta completar tres dosis; el grupo control (n = 23) no recibió antibiótico; en ambos grupos para el campo quirúrgico se utilizó iodopovidona al 10%. Se tomaron muestras de la conjuntiva en cuatro momentos diferentes, cultivadas en medios sólidos (agar chocolate, agar sangre) y en caldo de enriquecimiento (tioglicolato). Además se obtuvieron muestras de humor acuoso que fueron cultivadas en tioglicolato. La presencia de bacterias fue identificada cuantitativa y cualitativamente y la frecuencia de contaminación fue medida considerando el desarrollo de microorganismos en los medios de cultivo tanto líquido como sólido, y se contabilizaron los números de colonias (UFC) en el sólido. Resultados: Antes de la administración de ciprofloxacina al 0,3% se obtuvieron cultivos positivos en el 82,6 y 78,3% de los pacientes en los grupos de estudio y control, respectivamente. La administración de ciprofloxacina al 0,3% redujo significativamente las UFC en comparación con el grupo control (p < 0,05); inmediatamente después del uso de la iodopovidona el porcentaje de pacientes con cultivo positivo disminuyó a 21,7% en el grupo de estudio y a 8,7% en el grupo control; al final de la cirugía este porcentaje fue de 26 y 30,4%, respectivamente. El germen más frecuente fue el estafilococo coagulasa-negativo (66,7%) (AU)

Conclusión: La administración de ciprofloxacina al 0,3% reduce la carga bacteriana conjuntival en el período preoperatorio, pero no la erradica de forma significativa. La administración de iodopovidona erradica la biota conjuntival en el 50-70% de los pacientes operados de cataratas (AU)

Objective: To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. Patients and methods: Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n = 23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15 minutes starting one hour before surgery until 3 doses were completed. The control group (n = 23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. Results: Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P < 0.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%) (AU)

Conclusion: The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery (AU)

[Efficacy of topical 0.3% ciprofloxacin application in reducing the conjunctival biota of patients undergoing cataract extraction]. / Eficacia de la aplicación tópica de 0,3% ciprofloxacina en la reducción de la biota conjuntival de pacientes operados de cataratas.

OBJECTIVE: To determine the efficacy of topical 0.3% ciprofloxacin in reducing conjunctival biota in patients undergoing cataract surgery. PATIENTS AND METHODS: Experimental, prospective, randomized, controlled and single-blind study. Forty-six eyes of 46 patients were randomized into 2 groups, the study group (n=23) received topical 0.3% ciprofloxacin one day before surgery for six times, and on the day of the surgery one drop every 15minutes starting one hour before surgery until 3 doses were completed. The control group (n=23) did not receive any antibiotics. For both groups for the surgical field 10% povidone-iodine was applied. Samples from the conjunctiva were taken at four different times and then cultured on solid media (chocolate agar, blood agar) and enrichment broth (thioglycolate). The aqueous humor samples were also cultured in thioglycolate. The presence of bacteria was identified quantitatively and qualitatively, and the frequency of contamination was measured by considering the presence of bacteria in liquid and solid culture media. The number of colony forming units (CFU) was counted in the solid culture medium. RESULTS: Positive cultures were obtained in 82.6% and 78.2% of the patients in the study and control groups, respectively, before the administration of 0.3% ciprofloxacin. The administration of 0.3% ciprofloxacin significantly reduced the CFU compared to the control group (P<.05). Immediately after the use of povidone-iodine, the proportion of patients with a positive culture decreased to 21.7% in the study group, and 8.7% in the control group. At the end of the surgery, this percentage was 26% and 30.4%, respectively. The most common isolated pathogen was negative-coagulase Staphylococcus (66.7%). CONCLUSION: The administration of 0.3% ciprofloxacin reduces conjunctival bacterial load in the preoperative period. However, it was unable to eradicate the bacteria completely. The administration of povidone-iodine reduced conjunctival biota in 50%-70% of patients undergoing cataract surgery.

Viral load of human bocavirus-1 in stools from children with viral diarrhoea in Paraguay.

Since their discovery, four species of human bocavirus (HBoV) have been described in patients with respiratory and gastrointestinal diseases. However, a clear causal association between HBoV-1 and gastroenteritis has not been demonstrated. In this study, we describe the detection and quantification of HBoV-1 in stools from children with acute non-bacterial gastroenteritis using quantitative polymerase chain reaction. HBoV-1 genome was detected in 10.6% of stools with frequent association with rotavirus and norovirus. The median of HBoV-1 viral load was 1.88 × 104 genome/ml, lower than previously shown in secretions of patients with respiratory infections, without any obvious association between high viral load and presence of HBoV as single agent. Thus, although HBoV-1 was frequently detected in these patients, there is no clear causal association of this agent with diarrhoea. Indeed, HBoV-1 DNA in stools of patients with gastroenteritis without respiratory symptoms may be a remnant of previous infections or associated with prolonged shedding of virus in the respiratory or digestive tracts.

[Bacterial contamination of needles after intravitreal injection in Paraguay]. / Bakterielle Kontamination von Injektionskanülen nach intravitrealer operativer Medikamenteneingabe in Paraguay.

PURPOSE: The study was designed to prospectively evaluate the bacterial contamination of needles used for intravitreal injection during surgery. MATERIAL AND METHODS: Between December 2007 and December 2010, 549 eyes of 413 patients were treated with intravitreal injections of 1.25 mg bevacizumab. Of the patients 322 received a single injection and 91 multiple injections. Preoperatively the periorbital skin of all patients was treated with 10% povidone iodine (PVI) and the conjunctival sac was irrigated with 1% PVI. No pre-injection antibiotics were administered. Immediately after the injection the needles were rinsed 3 times in thioglycolate broth which was then cultured at 37°C for 5 days. As a negative control 73 sterile unused needles were treated in the same way. RESULTS: Out of the 549 needle points tested 8 (1,45%) were found to be contaminated after intravitreal injections. The isolated bacteria were coagulase negative Staphylococcus (n = 7), Propionibacterium acnes (n = 1) and Klebsiella pneumoniae (n = 1) (co-contamination in one case). CONCLUSION: Contamination of needles is minimal after prophylactic povidone iodine irrigation before intravitreal injections. Therefore, this prophylaxis technique is recommended before intravitreal injections in order to prevent postoperative infections.

PCR múltiple para la detección simultánea de los genes mecA y pvl en Staphylococcus spp / Multiplex PCR for simultaneous detection of mecA and pvl genes in Staphylococcus spp

Este estudio observacional descriptivo de corte transverso tuvo por objetivo estandarizar una PCR múltiple para la detección simultánea de los genes mecA y pvl en Staphylococcus spp. Se emplearon como cepas control: S. aureus ATCC 25923, S. aureus ATCC 43300 y un aislado de S. aureus portador de los genes mecA y pvl. La extracción de ADN se realizó por el método de ebullición. El límite de detección se estableció por medio de diluciones seriadas de ADN. Se determinó la aplicabilidad de la PCR múltiple testando 41 aislados de S. aureus y 51 Estafilococos coagulasa negativo (ECN) previamente caracterizados por métodos fenotípicos en noviembre del año 2009. Los productos de PCR fueron visualizados por electroforesis en gel de agarosa al 2% previa tinción con bromuro de etidio. Los productos de amplificación de la PCR múltiple presentaron tamaño esperado de 533pb y 433pb para los genes mecA y pvl respectivamente, con límites de detección de hasta 0,5 ng/µL. El gen mecA se detectó en 13 (31,7%) aislados de S. aureus y en 29 (56,7%) ECN. El gen pvl se detectó en 2 (4,9%) S. aureus y no fue detectado en ECN. La presencia del gen mecA tuvo 100% de concordancia con los métodos fenotípicos. Esta técnica es una herramienta útil en la confirmación de cepas de Estafilococos meticilino resistentes e identificación del gen pvl, además de ser relativamente sencilla con la ventaja de detectar ambos genes en una sola reacción

Frecuencia de serogrupos de estreptococos beta-hemolíticos enhisopados faríngeos de pacientes con faringitis / Frequency of beta-hemolytic streptococci serogroups in throat swabs of

El Streptococcus pyogenes o estreptococo beta-hemolítico (EBH) grupo A es la causa másfrecuente de faringitis bacteriana; su importancia radica en las secuelas no supurativasque puede desencadenar como la fiebre reumática aguda y la glomerulonefritis agudapost-estreptocócica. Casos de faringitis por grupos de EBH diferentes al grupo A,específicamente los del grupo C y G están documentados, pero su papel no estácompletamente claro. El objetivo de este estudio retrospectivo fue determinar lafrecuencia de serogrupos de EBH aislados de hisopados faríngeos de niños y adultos confaringitis, que acudieron al departamento de Microbiología del Laboratorio San Roque enAsunción-Paraguay, entre junio de 2006 a junio de 2007. Las muestras de hisopadosfaríngeos fueron cultivadas en agar sangre de carnero al 5 por ciento e incubadas por 48h a 35ºCen atmósfera de 5 por ciento de CO2 y las colonias beta-hemolíticas identificadas por métodosmicrobiológicos convencionales. De los 303 cultivos, 42 (13,9 por ciento) resultaron positivos paraEBH, de estos 25 (8,3 por ciento) fueron identificados como EBHA, 4 (1,3 por ciento) EBHC y 13 (4,3 por ciento)EBHG. La frecuencia relativa de los serogrupos fue de 59,5 por ciento del grupo A, 9,5 por ciento del grupoC y 31 por ciento del grupo G. Teniendo en cuenta que el 40,5 por ciento de los aislamientos de EBH eradiferente al grupo A, no debería considerarse al EBHA como único estreptococo patógenode la faringe, por lo tanto se debería identificar e informar todos los serogrupos en formarutinaria para un correcto diagnóstico y tratamiento, como una medida para prevenir laslesiones no supurativas que las infecciones por estos serogrupos pueden desencadenar.